The efficacy of smoking cessation strategies in people with chronic obstructive pulmonary disease: results from a systematic review

Abstract

Smoking cessation is the most effective way to reduce the risk of developing chronic obstructive pulmonary disease (COPD). It prevents or delays the development of airflow limitation and also reduces its progression. The objective of this study was to systematically review the effects of interventions for smoking cessation in people with COPD. Comprehensive searches of electronic and internet databases were carried out from 1966 to March 2002, using the Cochrane Airways Group search strategy. The reference lists of all selected randomized trials and relevant reviews were inspected for additional published reports and citations of unpublished research. We evaluated the efficacy of behavioural interventions (e.g. counselling), pharmacotherapy (nicotine replacement therapy and non-nicotine therapy such as bupropion), and combinations of both. The main clinical outcome measure was prolonged abstinence after at least 6 months, confirmed by a biochemical test. Five trials comprising 6491 patients with COPD were included. Results of the Lung Health Study show that, by using an intensive behavioural (relapse prevention) programme combined with nicotine replacement therapy, prolonged abstinence rates are not only significantly higher compared with no intervention, but the difference in efficacy was sustained for over 5 years. A 12-week treatment course with bupropion sustained release combined with individual counselling, however, did not result in significantly higher prolonged abstinence rates after 12 months. Present evidence suggests that the most effective intervention for prolonged smoking cessation in patients with COPD is the combination of nicotine replacement therapy, coupled with an intensive, prolonged relapse prevention programme.

Smoking Cessation Interventions for COPD: A Review of the Literature

“…In comparison to the previous 2 systematic reviews, 14,15 this review did not use the full Delphi list 17 to assess the quality of the studies. The Delphi list was developed as a minimum reference standard for randomized controlled trials on many different research topics, and, rather than replace, was intended to be used alongside other criteria lists.…”

“…It was felt that the subject area of this review required an active role on the part of the subject in terms of behavioral support and a degree of control over their level of engagement with behavior change techniques. Consequently, it was decided that the elements of blinding of the care provider and the subject were not valid items, which, as Wagena et al 14 discussed, led to internal validity difficulties for their systematic review when comparing psychosocial interventions. To overcome this, a number of quality assessment points were added that also aimed to increase the validity of the studies selected.…”

“…In their review of 5 studies undertaken between 1991 and 2001, Wagena et al 14 concluded that combining psychosocial interventions and pharmacologic interventions resulted in better outcomes than either no intervention or psychosocial interventions alone. This latter finding of the lack of evidence to support the effectiveness of any psychosocial intervention alone for smokers with COPD was due to a lack of high-quality studies comparing a combination of interventions with no intervention.…”

“…The aim of this systematic review is to build on, update, and improve the findings of the earlier reviews by Wagena et al 14 and Strassman et al, 15 to identify the most effective stop smoking intervention approach for smokers with COPD. Changes were made to the search criteria, to identify relevant studies, such as terms to identify studies with a psychological element to the intervention.…”

“…The references of the included studies were screened for additional papers, and the following journals were Search Terms. The following search terms used in the original systematic review by Wagena et al 14 were used: COPD*, lung-diseases-obstructive*, emphysem*, bronchit*, tobacco, nicotine, smoking, smoking-cessation, tobacco-use-disorder, tobacco-smokeless, anti-smoking, quit*, stop*, cessat*, ceas*, abstin*, abstain*, control*, smok*, giv*, tobacco*.…”